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detethering

Tethered cord can cause neurological, orthopaedic and sphincteric problems in children and detethering surgery may prevent or reverse these problems.

Untethering (tethered cord release) is the gold standard treatment for TCS. However, untethering carries risks of spinal cord injury and postoperative retethering 1)

Intraoperative MEP improvement occurs in about 50 % of the patients following successful untethering. This finding probably provides support to the ischemic theory of tethered cord syndrome.

Surgical detethering led to a reduction in the CSF levels of the markers of anaerobic metabolism and neuronal injury. There was also a reduction in the latencies of the SSEP waves, indicating better electrophysiologic functioning of the cord 2)

Shifting the tethered cord and lipoma to the dorsal side by harnessing the lumbar lordosis instead of detethering, is a viable treatment option for tethered cord syndrome 3).

1)
Kokubun S, Ozawa H, Aizawa T, Ly NM, Tanaka Y. Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. J Neurosurg Spine. 2011 Jul;15(1):21-7. doi: 10.3171/2011.2.SPINE10114. Epub 2011 Apr 15. PubMed PMID: 21495816.
2)
Maurya VP, Rajappa M, Wadwekar V, Narayan SK, Barathi D, Madhugiri VS. Tethered cord syndrome - a study of the short term effects of surgical detethering on markers of neuronal injury and electrophysiologic parameters. World Neurosurg. 2016 Jul 12. pii: S1878-8750(16)30524-1. doi: 10.1016/j.wneu.2016.07.005. [Epub ahead of print] PubMed PMID: 27422680.
3)
Murata Y, Kanaya K, Wada H, Wada K, Shiba M, Kato Y. Reduction of caudal traction force using dural sac opening rather than spinal cord detethering for tethered cord syndrome caused by lipomyelomeningocele: a case report. Spine J. 2014 Oct 1;14(10):e1-3. doi: 10.1016/j.spinee.2014.02.031. Epub 2014 Mar 5. PubMed PMID: 24613376.
detethering.txt · Last modified: 2018/12/11 08:28 by administrador